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(See the images below.) Many of these components of the lumber spine have sensory innervation that can generate nociceptive signals representing responses to tissue-damaging stimuli. Most chronic LBP cases most likely involve mixed nociceptive and neuropathic etiologies.

Biomechanically, the movements of the lumbar spine consist of the cumulative motions of the vertebrae, with 80-90% of the lumbar flexion/extension occurring at the L4-L5 and L5-S1 intervertebral disks.

Lambeek et al assessed the efficacy of an integrated care program for chronic LBP against that of a more conventional care program, as a means of helping patients with this condition return to work.

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For individuals older than 45 years, mechanical LBP is the third most common cause of disability, and a careful history and physical examination are vital to evaluation, treatment, and management.

Perhaps the most widely reviewed (and controversial) guideline was published in 1994 by the Agency for Health Care Policy and Research titled "Acute Lower Back Problems in Adults: Clinical Practice Guidelines."This initiative involves patient and professional health care organizations, government agencies, and industries working collaboratively to increase the awareness of bone and joint diseases while increasing the information and research to address this major health care issue.

Smoking in males was linked with an increased risk of first-time nonsurgical hospitalization and second-time hospitalization for surgical treatment.

Similarly, a study by Yang and Haldeman, derived from the 2009-2012 National Health Interview Survey of the civilian US population, indicated that risk factors for LBP include current or previous smoking, current or previous alcohol use, lack of sleep, obesity, and lack of leisure-time physical activity.

Mechanical LBP due to cumulative trauma tends to occur more commonly in the workplace.

In a systematic study review, Chen et al investigated whether a sedentary lifestyle (which the authors defined as including sitting for prolonged periods at work and during leisure time) is a risk factor for LBP.However, the investigators found no significant difference in pain reduction between the 2 groups at 12 months.The severity of an acute traumatic event varies widely, from twisting one's back to being involved in a motor vehicle collision.The physiatrist represents one type of medical specialist who can evaluate, diagnose, treat, and manage LBP by using medical and nonsurgical procedures and interventions.The physiatrist may have the best functional understanding of all specialists in the treatment and management of mechanical LBP.Because 1 in 5 Americans will be age 65 or older by 2030, 65 million people (20% of the total population) will be affected by musculoskeletal impairments, with LBP ranking among the most common problems.

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